DAQ-2025-001331

1

DAQC-212-25
Site ID 10096 (B4)

MEMORANDUM

TO: STACK TEST FILE – SUNNYSIDE COGENERATION ASSOCIATES – EU #1

THROUGH: Harold Burge, Major Source Compliance Section Manager

FROM: Robert Sirrine, Environmental Scientist

DATE: February 25, 2025

SUBJECT: Source: Circulating Fluidized Bed Combustion Boiler (EU #1)
Location: 1 Power Plant Road, Sunnyside, Carbon County, Utah
Contact: Rusty Netz – 435-888-4476 ex107
Tester: Montrose Air Quality Services, LLC, Craig Kormylo 303-495-3936
FRS ID#: UT0000004900700030
Permit #: 700030005 dated March 8, 2023
Subject: Review of Pretest Protocol Dated February 18, 2025

On February 21, 2025, the Utah Division of Air Quality (DAQ) received a pretest protocol for emissions
testing of the Sunnyside EU#1 located in Sunnyside, Carbon County, Utah. Testing will be performed
August 5, 2025, and continue over a 30-day operating period to determine Hg emission rates and
demonstrate continuing compliance with the MATS Hg LEE requirements found in 40 CFR 63 Subpart
UUUUU and permit Conditions II.B.2.m(4) and (5), and II.B.2.m.1(c).

PROTOCOL CONDITIONS:

1. RM 30B used to determine total vapor phase mercury emissions: OK
2. ALT -091 used to determine moisture content in lieu of RM4: OK
DEVIATIONS: No deviations were noted.

CONCLUSION: The protocol appears to be acceptable.

RECOMMENDATION: Send attached protocol review and test date confirmation notice.

ATTACHMENTS: Stack test protocol dated February 18, 2025 * - / $ - - $ )
,* iuuth,
DIVISION OF AIR OUALITY
Sunnyside Cogeneration Associates
P.O, Box t59 .Suunyside, Utah 84539 . (435) 888_4476 .Fax [phone]
February 18, 2025
Harold Burge
Utah Divlsion of Air euality
195 North 1950 West
Salt Lake Clty, Utah 8411G
Subject:Protocol for Mercury Stack Testing to
Demonstrate On-Going LEE status
Sunnyslde Cogeneration Associates (SCA)
Dear Mr. Burge:
lncluded is SCA's Protocol for Mercury stack Testing to Demonstrate on-Going (LEE) status, TheHg testing pertains to the requirements of utility MAcr 40 cFR G3 subpart uuuuu. scA will continuewlth an annual 30'day Hg test to dernonstrate Low Emitting EGU status (LEE), The test will begin August5,2025.
we look forward to working with you to comply with the requirements of this regulation. lf youhave any questions or concerns, please contact Rusty Netz or myself at (435) ggg-4476.
Thank You,
,?lil,Q)t'it'6'(,.
Michael trrlosley /
Agent for
Sunnyside Cogeneration Associates
Rusty Netz
- UTAH DFPARI MEXT-F-
EJ-y!EON-ry1-F=NIAL Q UAL I rY
DIVISION OF AIR OUALITY
Source Test PIan for
2(J25 LEE Demonstration
Unit EU#1
Sunnyside Cogeneration Associates
Sunnyside, Utah
Prepared For:
Sunnyside Cogeneration Associates
1 Power Plant Road
Sunnyside, Utah 84539
Prepared By:
Montrose Air Quality Services, LLC
990 West 43rd Avenue
Denver, CO 80211
For Submission To:
Utah Division of Air Quality
195 North 1950 West
Salt Lake City, UT 84116
Document Number: GPO43AS-O25822-PP-673
Proposed Test Date: August 5, 2lJ25
Submittal Date: July 5,2025
I certify that, to the best of my knowledge, the information contained in this document is
complete and accurate and conforms to the requirements of the Montrose Quality
Signature:Date:
Title:
2/14/2O2s
Name: Matthew Parks QA/QC Analyst
I have reviewed, technically and editorially, details and other appropriate written materials
contained herein. I hereby certify that to the best of my knowledge the presented material
is authentic and accurate and conforms to the requirements of the Montrose Quality
Management System and ASTM D7036-04.
Signature:
Name:
Date:
Title:
2/L4/202s
Tim Wojtach Account Manager
Table of Contents
Section Paoe
1.0 Introduction,....... ...................5
1. 1 Summary of Test Program .... ... 5
t.2 Applicable Regulations and Emission Limits ....... 6
1.3 Key Personnel........... ..............7
2.0 Plant and Sampling Location Descriptions............. .........8
2.L Process Description, Operation, and Control Equipment........... .........8
2.2 Flue Gas Sampling Locations ............ I
2.3 Operating Conditions and Process Data...... .........9
2.4 Plant Safety............. ..........9
2.4.1 Safety Responsibilities ...............9
2.4.2 Safety Program and Requirements .........10
3.0 Sampling and Analytical Procedures .................12
3.1 Test Methods............ .......t2
3.1.1 EPA Method 308 ......... ..........12
3.2 Process Test Methods............ .........13
4.0 Quality Assurance and Reporting........... .................14
4.L QA Audits. ......L4
4,2 Quality Control Procedures ....14
4.2.1 Equipment Inspection and Maintenance .....L4
4.2.2 Audit Samples .......14
4.3 Data Analysis and Validation ...........14
4.4 Sample Identification and Custody .......15
4.5 Quality Statement ..........15
4.6 Reporting ...........15
4.6.1 Example Report Format .......16
4.6.2 Example Presentation of Test Resu|ts.............. .......17
List of Appendices
Appendix A Supporting Information ......... ..........18
Appendix A.1 Units and Abbreviations ....19
Appendix A.2 Accreditation Information/Certifications ........ .......27
Appendix "S" Field Work Safety P1an......... .............29
List of Tables
Table 1-1 Summary of Test Program and Proposed Schedule... ........ 5
Table 1-2 Reporting Units and Emission Limits ...............6
Table 1-3 Test Personnel and Responsibilities.... ...................8
Table 2-1 Sampling Location(s)......... ............ B
Table 4-1 Example <Parameter> Emissions Results - Unit Name ........L7
List of Figures
Figure 3-1 EPA Method 30B Sampling Train ....13
Figure 4-1 Typical Report Format .................16
1.O Introduction
1.1 Summary of Test Program
Sunnyside Cogeneration Associates contracted Montrose Air Quality Services, LLC
(Montrose) to perform an emissions test program at the Sunnyside Power Plant located near
Sunnyside, Utah. The tests are conducted to determine compliance with the emission limits
in 40 CFR Part 63, Subpart UUUUU.
The specific objectives are to:
. Perform annual mercury emissions testing on the exhaust stack of Unit
EU#1 over a 30-day operating period
. Conduct the test program with a focus on safety
Montrose will provide the test personnel and the necessary equipment to measure emissions
as outlined in this test plan. Facility personnel will provide the process and production data
to be included in the final report. A summary of the test program and proposed schedule is
presented in Table 1-1.
Table 1-l
Summary of Test m and Proposed Schedule
To simplify this test plan, a list of Units and Abbreviations is included in Appendix A.
Throughout this test plan, chemical nomenclature, acronyms, and reporting units are not
defined. Please refer to the list for specific details.
1.2 Applicable Regulations and Emission Limits
The results from this test program are presented in units consistent with those listed in the
applicable regulations or requirements. The reporting units and emission limits are
presented in Table 1-2.
Table 1-2
Repofting Units and Emission Limits
Unit EU#1
40 CFR Part 63, Subpart UUUUU
(Low Emitting EGU Limit)
40 CFR Part 63, Subpart UUUUU
(Low Emitting EGU Limit)
40 CFR Part 63, Subpart UUUUU
(Low Emitting EGU Limit)
A list of project participants is included below:
Facility Information
Source Location:
1.3 Key Personne!
Project Contact:
Role:
Company:
Telephone:
Email:
Agency Information
Regulatory Agency:
Agency Contact:
Telephone:
Email:
Sunnyside Cogeneration Associates
Sunnyside Power Plant
1 Power Plant Road
Sunnyside, UT 84539
Rusty Netz
Environmental Advisor
Sunnyside Cogeneration Associates
[phone] x107
[e-mail]
Utah Department of Air Quality
Rob Leishman
(801) s36-4438
[e-mail]
Testing Company Information
Testing Firm: Montrose Air Quality Services, LLC
Contact: Craig Kormylo
Title: District Manager
Telephone: [phone]
Email: [e-mail]
Table 1-3 details the roles and responsibilities of the test team.
Table 1-3
Test Personnel and Responsibilities
2.O Plant and Sampling Location Descriptions
2.1 Process Description, Operation, and Control
Equipment
The Sunnyside Cogeneration Facility is a steam-electric Aenerating power plant located in
Sunnyside, Carbon County, Utah. The plant consists of a circulating fluidized bed (CFB)
combustion boiler designated EU #1, an emergency backup diesel-fired pump, diesel storage
tanks, coal handling equipment, ash handling equipment and limestone handling equipment.
EU #1 has a rating of 700 mmBtu/hrand is equipped with limestone injection and a baghouse
for control of emissions. The EU #1 is fueled by coal refuse from the Sunnyside and Star
Point Refuse Piles. The flylbottom ash generated from the coal combustion is disposed of in
an on-site landfill or used for beneficial applications.
2.2 FIue Gas Sampling Locations
Actual stack measurements, number of traverse points, and location of traverse points will
be evaluated in the field as part of the test program, Table 2-1 presents the anticipated
stack measurements and traverse points for the sampling locations listed.
Table 2-l
Sampling Location
Sample location(s) are verified in the field to conform to EPA Method 1. Acceptable cyclonic
flow conditions are confirmed priorto testing using EPA Method 1, Section 11.4.
Operate mobile lab Facility interface, test crew coordination
Execute stack platform
responsibilities Preparation, support PM
2.3 Operating Conditions and Process Data
Emission tests are performed while the source/units and air pollution control devices are
operating at the conditions required by the applicable regulation. The units are tested when
operating normally.
Plant personnel are responsible for establishing the test conditions and collecting all
applicable unit-operating data. Data collected includes the following parameters:
. Relevant CEMS data
2.4 Plant Safety
Montrose will comply with all safety requirements at the facility. The facility Client Sponsor,
or designated point of contact, is responsible for ensuring routine compliance with plant
entry, health, and safety requirements. The Client Sponsor has the authority to impose or
waive facility restrictions. The Montrose test team leader has the authority to negotiate any
deviations from the facility restrictions with the Client Sponsor. Any deviations must be
documented.
2.4.L Safety Responsibilities
Planning
. Montrose must complete a field review with the Client Sponsor prior to the
project date. The purpose of the review is to develop a scope of work that
identifies the conditions, equipment, methods, and physical locations that will
be utilized along with any policies or procedures that will affect our work
. We must reach an agreement on the proper use of client emergency services
and ensure that proper response personnel are available, as needed
. The potential for chemical exposure and actions to be taken in case of
exposure must be communicated to Montrose. This information must include
expected concentrations of the chemicals and the equipment used to identify
the substances.
. Montrose will provide a list of equipment being brought to the site, if required
by the client
Project Day
. Montrose personnel will arrive with the appropriate training and credentials
for the activities they will be performing and the equipment that they will
operate
. Our team will meet daily to review the Project Scope, Job Hazard Assessment,
and Work Permits. The Client Sponsor and Operations Team are invited to
participate.
. Montrose will provide equipment that can intefface with the client utilities
previously identified in the planning phase and only work with equipment that
our client has made ready and prepared for connection
. We will follow client direction regarding driving safety, safe work permitting,
staging of equipment, and other crafts or work in the area
. As per 40 CFR Part 60 Subpaft A, Section 60.8, the facility must provide the
following provisions at each sample location:
o Sampling ports, which meet EPA minimum requirements for testing. The
caps should be removed or be hand-tight.
o Safe sampling platforms
o Safe access to the platforms and test ports, including any scaffolding or
man lifts
o Sufficient utilities to perform all necessary testing
. Montrose will use the client communication system, as directed, in case of
plant or project emergency
. Any adverse conditions, unplanned shutdowns or other deviations to the
agreed scope and project plan must be reviewed with the Client Sponsor prior
to continuing work. This will include any safe work permit and hazard
assessment updates.
Completion
. Montrose personnel will report any process concerns, incidents or near misses
to the Client Sponsor prior to leaving the site
Montrose will clean up our work area to the same condition as it was prior to
our arrival
We will ensure that all utilities, connection points or equipment have been
returned to the pre-project condition or as stated in the safe work permit. In
addition, we will walk out the job completion with Operations and the Client
Sponsor if required by the facility.
2.4.2 Safety Program and Requirements
Montrose has a comprehensive health and safety program that satisfies State and Federal
OSHA requirements. The program includes an Illness and Injury Prevention Program, site-
specific safety meetings, and training in safety awareness and procedures. The basic
elements include:
All regulatory required policies/procedures and training for OSHA, EPA,
FMCSA, and MSHA
Medical monitoring, as necessary
. Pre-test and daily toolbox meetings
. Continued evaluation of work and potential hazards
. Near-miss and incident reporting procedures as required by Montrose and the
Client
Montrose will provide standard PPE to employees. The PPE will include but is not limited to;
hard hats, safety shoes, glasses with side shields or goggles, hearing protection, hand
protections, and fall protection. In addition, our trailers are equipped with four gas detectors
to ensure that workspace has no unexpected equipment leaks or other ambient hazards.
The detailed Site Safety Plan for this project is attached to this test plan in Appendix "S".
3.O Sampling and Analytical Procedures
3.1 Test Methods
The test methods forthis test program have been presented in Table 1-1. Additional
information regarding specific applications or modifications to standard procedures is
presented below.
3.1.1 EPA Method 3OB
Determination of Total Vapor Phase Mercury Emissions from Coal-Fired
Combustion Sources Using Carbon Sorbent Traps
EPA Method 308 is a manual test method for measuring total vapor phase mercury (Hg)
emissions from coal-fired combustion sources using sorbent trap sampling and an extractive
or thermal analytical technique. The method includes sampling into duplicate sorbent traps,
which are analyzed using a sorbent trap mercury analyzer. This type of analyzer uses
thermal desorption with ultraviolet atomic absorption (UV AA) or ultraviolet atomic
fluorescent (UV AF) cold vapor analysis. Each trap consists of two equal-mass sections of
iodinated activated charcoal (Section 1 and 2). The results for Section 1 and Section 2 of
each tube are reported in nanograms (ng) of Hg per section, and then they are summed.
The charcoal sorbent is pre-checked to certify that mercury background levels are below the
detection limit of the laboratory instrument. Each trap is uniquely numbered, and the
sorbent batch number is printed on the outside of the glass tubes. One trap per run is pre-
spiked in the first sorbent section with a known quantity of elemental mercury, using a
proprietary gas-phase bulk spiking procedure. Each run includes two samples (A and B)
collected concurrently from a single representative sampling point in the exhaust stack
using a dual probe. Samples are drawn through the sorbent traps into a moisture knockout
loaded with desiccant, and then through a sampling orifice.
The typical sampling system is detailed in Figure 3-1.
Figure 3-l
EPA Method 3OB Sampling Train
Spke Sorb€ni fTh.m@upl.
Soruent Tr6p
H..t.d \houm Lin.
3.2 Process Test Methods
The applicable regulations do not require process samples to be collected during this test
program.
4.O Quality Assurance and Reporting
4.1 QA Audits
Montrose has instituted a rigorous QA/QC program for its air quality testing. Quality
assurance audits are performed as part of the test program to ensure that the results are
calculated using the highest quality data available. This program ensures that the emissions
data we report are as accurate as possible. The procedures included in the cited reference
methods are followed during preparation, sampling, calibration, and analysis. Montrose is
responsible for preparation, calibration, and cleaning of the sampling apparatus. Montrose
will also perform the sampling, sample recovery, storage, and shipping. Approved contract
laboratories may perform some of the preparation and sample analyses, as needed.
4.2 Quality Control Procedures
Montrose calibrates and maintains equipment as required by the methods performed and
applicable regulatory guidance. Montrose follows internal procedures to prevent the use of
malfunctioning or inoperable equipment in test programs. All equipment is operated by
trained personnel. Any incidence of nonconforming work encountered during testing is
reported and addressed through the corrective action system.
4,2.L Equipment fnspection and Maintenance
Each piece of field equipment that requires calibration is assigned a unique identification
number to allow tracking of its calibration history. All field equipment is visually inspected
prior to testing and includes pre-test calibration checks as required by the test method or
regulatory agency.
4.2.2 Audit Samples
When required by the test method and available, Montrose obtains EPA TNI SSAS audit
samples from an accredited provider for analysis along with the samples. Currently, the
SSAS program has been suspended pending the availability of a second accredited audit
sample provider. If the program is reinstated, the audit samples will be ordered. If required
as part of the test program, the audit samples are stored, shipped, and analyzed along with
the emissions samples collected during the test program. The audit sample results are
reported along with the emissions sample results.
4.3 Data Analysis and Validation
Montrose convefts the raw field, laboratory, and process data to reporting units consistent
with the permit or subpart. Calculations are made using proprietary computer spreadsheets
or data acquisition systems. One run of each test method is also verified using a separate
example calculation. The example calculations are checked against the spreadsheet results
and are inr^lr rderl in the final rennrt The "Standard Cnnditinnq" for this nrniprt are 7Q Q2
4.4 Sample Identification and Custody
The on-site Field Project Manager will assume or assign the role of sample and data
custodian until relinquishing custody. The sample custodian will follow proper custody
procedures before departing from the test site including:
. Assign the unique sample identification number to each sample
. Attach sample labels and integrity seals to all samples
. Complete COC form(s), ensuring that the sample identification numbers on
the samples match the sample identification numbers on the COC
. Pack and store samples in accordance with the test method requirements in
appropriate transport containers for protection from breakage, contamination,
or loss
. Keep samples in a secure locked area if not in the direct presence of Montrose
staff
The sample custodian will follow proper custody procedures upon arriving at the Montrose
office including:
. Remove samples and COC documents from vehicles and check into
designated secure sample holding areas
. Store samples requiring additional measures such as refrigeration or dry ice
appropriately
4.5 Quality Statement
Montrose is qualified to conduct this test program and has established a quality
management system that led to accreditation with ASTM Standard D7036-04 (Standard
Practice for Competence of Air Emission Testing Bodies). Montrose participates in annual
functional assessments for conformance with D7036-04 which are conducted by the
American Association for Laboratory Accreditation (A2LA). All testing performed by Montrose
is supervised on site by at least one Qualified Individual (QI) as defined in D7036-04
Section 8.3.2. Data quality objectives for estimating measurement uncertainty within the
documented limits in the test methods are met by using approved test protocols for each
project as defined in D7036-04 Sections 7.2,L and 12.10. Additional quality assurance
information is included in the appendices. The content of this test plan is modeled after the
EPA Emission Measurement Center Guideline Document (GD-042).
4.6 Reporting
Montrose will prepare a final report to present the test data, calculations/equations,
descriptions, and results. Prior to release by Montrose, each report is reviewed and ceftified
25 days of the completion of the field work. The report will include a series of appendices to
present copies of the intermediate calculations and example calculations, raw field data,
laboratory analysis data, process data, and equipment calibration data.
4.6.L Example Report Format
The report is divided into various sections describing the different aspects of the source
testing program. Figure 4-1 presents a typical Table of Contents for the final report.
Figure 4-1
Typical Repoft Format
Cover Page
Certification of Repoft
of Contents
Section
1.0 Introduction
2.0 Plant and Sampling Location Descriptions
3.0 Sampling and Analytical Procedures
4.0 Test Discussion and Results
5.0 Internal QA/QC Activities
Appendices
A Field Data and Calculations
B Facility Process Data
C Laboratory Analysis Data
D Quality Assurance/Quality Control
E Regulatory Information
4.6.2 Example Presentation of Test Results
Table 4-1 presents the typical tabular format that is used to summarize the results in the
final source test report. Separate tables will outline the results for each target analyte and
compare them to their respective emissions limits.
Table 4-1
Example <Parameter> Emissions Results -
Unit Name
Date xx xx xx XX
Tlme XX xx xx xx
Process Data
parameter 1, units XX xx xx XX
parameter 2, units xx xx XX XX
Sampling & Flue Gas Parameters
sample duration, minutes xx xx xx xx
Oz, o/o volume dry xx XX XX XX
COz, o/o volume dry xx xx xx xx
flue gas temperature, oF XX XX xx xx
moisture content, o/o volume xx XX XX XX
volumetric flow rate, dscfm xx XX xx XX
<Parameter)
ppmvd xx XX xx xx
ppmvd @ 15o/o Oz xx xx xx XX
lblhr xx XX XX xx
tons/yr XX xx xx xx
lb/MMBtu XX XX xx xx
Appendix A
Supporting Information
Appendix A.1
Units and Abbreviations
66 ltgN,r+gp.H
@x%02
lccl
ldloc
oF
oR
" Hzo
13.6
AH
AP
e
pg
P,
Pw
acfm,\
&
Btu
BE
c8
Cers
Coi,
cf or fts
cfm
Gc",
cM
cm or m3
Cuo
co
cp
cs
CS
cs
cv
D
dcf
dcm
Dn
Ds
dsc'f
dscfm
dscm
Fd
fpm
fps
ft
42
UNlTS AND ABBREVIATIONS
corrected to X% oxygen (conected for dilution air)
absolute value of the confidence coefficient
absolute value of the mean differences
degrees Celsius
degrees Fahrenheit
degrees Rankine
inches of water column
specific gravity of mercury
pressure drop across orifice meter, inches H2O
velocity head of stack gas, inches H2O
total sampling time, minutes
microgram
density of acetone, mg/ml
density of water, 0.9982 g/ml or 0.002201 lb/ml
actual cubic feet of gas per minute at stack conditions
cross-sectional area of nozzle, ff
cross-sectional area of stack, square feet (ft')
British thermal unit
proportion by volume of water vapor in gas stream
particulate matter concentration in stack gas, gr/acf
average unadjusted gas concentration, ppmv
measured concentration of calibration gas, ppmv
cubic feet
cubic feet per minute
average gas concentration adjusted for bias, ppmv
average of initial and final system bias check responses from upscale calibration gas, ppmv
cubic meters
actual concentration of the upscale calibration gas, ppmv
average of initial and final system bias check responses from lowlevel calibration gas, ppmv
pitot tube coefficient
particulate matter concentration in stack gas, gr/dscf
calibration span, % or ppmv
measured concentration of calibration gas, ppmv
manufactured certified concentration of calibration gas, ppmv
drift assessment, % of span
dry cubic feet
dry cubic meters
diameter of nozzle, inches
diameter of stack, inches
dry standard cubic feet
dry standard cubic feet per minute
dry standard cubic meters
F-factor, dscf/MMBtu of heat input
feet per minute
feet per second
feet
ear rara faal
60 l$?N,T+gp.H
I
in
k
K
K3
&
kg
Kp
kwscfh
I
lb/hr
lb/MMBtu
lpm
m
M
m'
m8
Md
meq
mg
Mg
min
ml or mL
mm
MM
MMBtu/hr
mn
mol
mol. wt. or MW
MS
MW
n
ng
nm
oI bar
ps
Ps
P,
ppb
ppbv
ppbvd
ppm
ppmv
ppmvd
ppmvw
Ps
psi
psia
psig
P.,,
UNITS AND ABBREVIATIONS
percent of isokinetic sampling
inch
kilo or thousand (metric units, multiply by t031
kelvin (temperature)
conversion factor 0.0154 gr/mg
conversion factor 0.002668 ((in. HgXftr))/((mlX'R))
kilogram
pitot tube constant (85.49 fVsec)
thousand wet standard cubic feet per hour
liters
pounds per hour
pounds per million Btu
liters per minute
meter or milli
thousand (English units) or mega (million, metric units)
cubic meters
mass of residue of acetone after evaporation, mg
molecular weight of stack gas; dry basis, lb/lb-mole
milliequivalent
milligram
megagram (106 grams)
minute
milliliter
millimeter
million (English units)
million Btu per hour
total amount of particulate matter collected, mg
mole
molecular weight
molecular weight of stack gas; wet basis, lb/lb-mole
molecular weight or megawatt
number of data points
nanogram
nanometer
barometric pressure, inches Hg
picogram
stack static pressure, inches H2O
barometric pressure of dry gas meter, inches Hg
parts per billion
parts per billion, by volume
parts per billion by volume, dry basis
parts per million
parts per million, by volume
parts per million by volume, dry basis
parts per million by volume, wet basis
absolute stack gas pressure, inches Hg
pounds per square inch
pounds per square inch absolute
pounds per square inch gauge
standard absolute oressure. 29.92 inches Ho
64\ f+?N,I+gLH
SBnn"t
SB,
scf
sclh
scfm
scm
scmh
sec
sf, sq. ft., or ft2
std
t
T o.szs
Ta
Tm
ton or t
tph or tons/hr
tpy or tons/yr
T"
T.,o
va
Vt.
Vmlstol
vm
vs
Vrc(sto)
Vwilstol
Vmg(sto)
W
wa
Wr.p
Wss
UNITS AND ABBREVIATIONS
post-run system bias check, % of span
pre-run system bias check, % of span
standard cubic feet
standard cubic feet per hour
standard cubic feet per minute
standard cubic meters
standard cubic meters per hour
second
square feet
standard
metric ton (1000 kg)
t-value
absolute average ambient temperature, oR (+459.67 for English)
absolute average dry gas meter temperature, oR (+459.67 for English)
ton = 2000 pounds
tons per hour
tons per year
absolute average stack gas meter temperature, oR (+459.67 for English)
absolute temperature at standard conditions
volt
volume of acetone blank, ml
volume of acetone used in wash, ml
total volume H2O collected in impingers and silica gel, grams
volume of gas sampled through dry gas meter, ftJ
volume of gas measured by the dry gas meter, corrected to standard conditions, dscf
stack gas volume sampled, acf
volume collected at stack conditions through nozzle, acf
average stack gas velocity, feet per second
volume of water vapor condensed, corrected to standard conditions, scf
volume of water vapor in gas sampled from impingers, scf
volume of water vapor in gas sampled from silica gel, scf
watt
weight of residue in acetone wash, mg
total weight of impingers, grams
total weight of silica gel, grams
dry gas meter calibration factor, dimensionless
66 l+?.N,r+gLH
AAS
ACDP
ACE
AD
ADL
AETB
AS
ASTM
BACT
BDL
BHP
BIF
BLS
cc
CD
CE
CEM
CEMS
CERMS
CET
CFR
CGA
CHNOS
CNCG
CO
coc
COMS
CPM
CPMS
CT
CTM
CTO
CVAAS
D6
DE
Dioxins
DLL
DNCG
ECD
EIT
ELCD
EMPC
EPA
EPRI
ES
ESP
EU
FCCU
FGD
FI
FIA
FID
FPD
trPtr,
ACRONYMS
atomic absorption spectroscopy
air contaminant discharge permit
analyzer calibration error, percent of span
absolute difference
above detection limit
Air Emissions Testing Body
applicable standard (emission limit)
American Society For Testing And Materials
best achievable control technology
below detection limit
brake horsepower
boiler and industrial furnace
black liquor solids
confidence coefficient
calibration drift
calibration error
continuous emissions monitor
continuous emissions monitoring system
continuous emissions rate monitoring system
calibration error test
Code of Federal Regulations
cylinder gas audit
elemental analysis for determination of C, H, N, O, and S content in fuels
concentrated non-condensable gas
catalytic oxidizer
chain of custody
continuous opacity monitoring system
condensible particulate matter
continuous parameter monitoring system
combustion turbine
conditional test method
catalytic thermal oxidizer
cold vapor atomic absorption spectroscopy
equivalent diameter
destruction efliciency
polychlorinated dibenzo-p-dioxins (pcdd's)
detection level limited
dilute non-condensable gas
electron capture detector
Engineer ln Training
electoconductivity detector (hall detector)
estimated maximum possible concentration
US Environmental Protection Agency
Electric Power Research lnstitute
emission standard (applicable limit)
electrostatic precipitator
emission unit
fluid catalytic cracking unit
fl ue gas desulfurization
flame ionization
fl ame ionization analyzer
flame ionization detector
fl ame photometric detector
filfarehla narlinr rlato mattor
6/.} I+?N,I+ST.H
GC/MS
GFAAS
GFC
GHG
HAP
HC
HHV
HPLC
HRGC/HRMS
HRSG
IC
ICAP
ICPCR
ICP.MS
IR
rso
KW
LFG
LHV
LPG
MACT
MDI
MDL
MNOC
MRL
MS
NA
NCASI
NCG
ND
NDIR
NESHAP
NG
NIOSH
NIST
NMC
NMOC
NMVOC
NPD
NSPS
OSHA
PAH
PCB
PCWP
PE
PFAS
PI
PID
PM
PMro
PMz.s
POM
t?
ACRONYMS
gas chromatography/mass spectroscopy
graphite furnace atomic absorption spectroscopy
gas filter correlation
greenhouse gas
hazardous air pollutant
hydrocarbons
higher heating value
high performance liquid chromatography
high-resolution gas chromatography/high-resolution mass spectroscopy
heat recovery steam generator
ion chromatography
inductively-coupled argon plasmography
ion chromatography with a post-column reactor
inductively coupled plasma-mass spectroscopy
infrared radiation
lnternational Standards Organization
kilowatts
landfill gas
lower heating value
liquified petroleum gas
maximum achievable control technology
methylene diphyenyl diisocyanate
method detection limit
maximum normal operating conditions
method reporting limit
mass spectrometry
not applicable or not available
National Council For Air And Steam lmprovement
non-condensable gases
not detected
non-dispersive infrared
National Emissions Standards For Hazardous Air Pollutants
natural gas
National lnstitute For Occupational Safety And Health
National lnstitute Of Standards And Technology
non-methane cutter
non-methane organic compounds
non-methane volatile organic compounds
nitrogen phosphorus detector
New Source Performance Standards
Occupational Safety And Health Administration
polycyclic aromatic hydrocarbons
polychlorinated biphenyl compounds
plywood and composite wood products
Professional Engineer
per- and polyfluoroalkyl substances (PFAS)
photoionization
photoionization detector
particulate matter
particulate matter less than 10 microns in aerodynamic diameter
particulate matter less than 2.5 microns in aerodynamic diameter
polycyclic organic matter
performance specifi cation
60 l*?N,r+gp.I
OA/OC
QI
QSTI
RA
RAA
RACT
RATA
RCTO
RICE
RM
RTO
SAM
SCD
SCR
SD
Semi-VOST
SRM
TAP
TBD
TCA
TCD
TGNENMOC
TGNMOC
TGOC
THC
Ttc
TO
TO
TPM
TSP
TTE
ULSD
UV
VE
voc
VOST
WC
WWTP
ACRONYMS
quality assurance and quality control
Qualified lndividual
Qualifi ed Source Testing lndividual
relative accuracy
relative accuracy audit
reasonably available control technology
relative accuracy test audit
rotary concentrator thermal oxidizer
stationary reciprocating internal combustion engine
reference method
regenerative thermal oxidizer
sulfuric acid mist
sulfur chemiluminescent detector
selective catalytic reduction system
standard deviation
semivolatile organic compounds sample train
standard reference material
toxic air pollutant
to be determined
thermal conductivity analyzer
thermal conductivity detector
total gaseous non-ethane non-methane organic compounds
total gaseous non-methane organic compounds
total gaseous organic compounds
total hydrocarbons
tentatively identified compound
thermal oxidizer
toxic organic (as in EPA Method TO-15)
total particulate matter
total suspended particulate matter
temporary total enclosure
ultra-low sulfur diesel
ultraviolet radiation range
visible emissions
volatile organic compounds
volatile organic sample train
water column
waste water treatment plant
66 l+gN,T+gp.H
CHEMICAL NOMENGLATURE
Ag
As
Ba
silver
arsenic
barium
Be beryllium
C carbonCd cadmiumCdS cadmium sutfide
CH2O formaldehyde
CH3CHO acetaldehyde
CH3OH methanol
CHr methane
C2H4O ethylene oxide
CzHo ethane
CaH4O acrolein
CaH6O propionaldehyde
CsHg propane
C6HsOH phenol
ClO2 chlorine dioxide
CO carbon monoxideCo cobalt
COz carbon dioxide
Cr chromiumCu copperEtO ethylene oideEIOH ethyl alcohol (ethanol)
hydrogen
water
flzOz hydrogen peroxide
HzS hydrogen sulfide
H2SO4 sulfuric acid
HCI hydrogen chlorideHg mercuryIPA isopropyl alcoholMDI methylene diphyenyl diisocyanate
MeCl2 methylene chloride
MEK methyl ethy'l ketoneMeOH methanolMn manganese
nitrogen
ammonia
nickel
nitric oxide
nitrogen dioxide
nitrogen oxides
orygenP phosphorusPb leadPCDD polychlorinated dibenzo-p{ioxins
Se
Soz
Sos
SO,
TCDD
TCDF
TGOC
THC
TI
TRS
Zn
selenium
sulfur dioxide
sulfur trioxide
sulfur oxides
tetrachlorodibenzodioxi n
tetrachlorod ibenzof u ran
total gaseous organic concentration
total hydrocarbons
thallium
total reduced sulfur compounds
zinc
Clz
H2
Hzo
N2
NHs
Ni
NO
Noz
NO,
o2
Appendix A.2
Accreditation Informatio n / Certifications
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Appendix *S"
Field Work Safety Plan
MI+gN,T+g[H
SITE SAFETY PLAN BOOKLET
Client Project Manager:
,arrMLJNlRL))t
Site Safety
Purpose
Page 1 of 2
Plan and JHA Purpose and lnstructions
Employee safety is the top priority of Montrose Environmental Group. All employees must be
trained to assess and mitigate hazards. The District Manager and Project Manager are
responsible to ensure all hazards have been properly identified and managed. All employees
have Stop Work Authority in all situations where an employee feels they or their co-worker
cannot perform a job safely or if there is a task for which they have not been adequately trained.
The Site Safety Plan (SSP) has been developed to help assist Montrose test crews with
identifying physical and health hazards and determining how the hazards will be managed.
Additionally, the SSP will help each crew manage the safety of the employees by providing
emergency procedures and information. The booklet contains a several safety forms that may
be required in the field.
lnstructions
The SSP consists of the following:
1. A Pre-Mobilization Test Plan - To be completed in it's entirety by the client project Manager
prior to the test.
2. A Job Hazard Analysis is a standardized, two-page, fillable form that is used to evaluated the
tasUsite's particular hazards and controls. The form also includes a daily toolbox topic and
daily hazard review with sign off by the team. The client Project Manager is responsible to
complete the JHA form through section 8. Upon arrival at the test site, the team will review the
form for accuracy, making any corrections requiied and complete the remainder of the JHA.
Section 9 will require at least three tasks, hazards and controls be identified for the project.
Each team member has the option to discuss making changes or adding to the JHA and must
sign on the Job Hazard Analysis form in agreement and sign in Section 10. The JHA is to be
modified when conditions change. A toolbox meeting with a daily topic in addition to a review of
the hazard analysis is required daily for the duration of the test. An additional sheet of paper
with the toolbox topic and signatures can be added to the SSP packet.
3. Hazard Control Matrix - contains useful information on both engineering and
administrative controls that a crew can use to reduce or eliminate the hazards they have
observed plus applicable PPE that may be required.
4. Emergency Action Plan - The Job Supervisor/ Client Project Manager (CPM) will complete
the Emergency Action Plan form and ensure that all employees are familiar with the facility
emergency and evacuation procedures, assembly/ rally points, alert systems, and signals prior
to work commencing. ln the event of an emergency situation/ evacuation, the Job Supervisor/
CPM will maintain a roster and be responsible for accounting for all employees. The Job
Supervisor/ CPM will ensure that this Emergency Action Plan Form is completed,
communicated to all employees, signed, and posted.
5. Additional Forms, as applicable
6A MON I RUSE
Page2 of 2
Site Safety Plan and JHA Purpose and lnstructions
The SSP is a living document. The Project Manager should continually update their SSPs as
new information and conditions change or if new hazards are presented.
Each completed SSP should be maintained with the Test Plan in the office for a period of 3
years. There will be an audit process developed for the Site Safety Plans.
ry \,vtL)N I RL))I
PRE.MOBILIZATION TEST INFORMATION
Page 1 of2
PROJECT NAM E/LOCATION :
TEST DATE:
PROJECT #:
PROJECT MANAGER:
TEST SCOPE:
SITE CONTACT: Name:Contact Phone:
Source Tvpe: New Source: _ Revisit: _
Coal Fired Electric Utility: _ Ethanol Plant: _
Prj#/Dateffech:
ChemicalMfg. of
CemenULime Kiln Plant: _ Specialty Mfg. of:Other:
Anticipated Effluent Composition - check all that apply and fill in expected concentration in ppm/%
tr
VOC
tr
co
Engineering Controls to be lmplemented:
tr
NOx
tr
other
lf other, explain:
Flammable:Toxic:Dust:
tr
SOz
Corrosive:
Additional Safety Equipment Required:
Personal gas monitors: _
Respiratory Protection :
Half Face_ Full Face_ HEPA Filters_ Supplied Air: _ (Safety Dept. Approval)
Approximate Flue Gas Temperatures, (F)
below 210 210 to 450 450 to 950 above 950 other
lf other, explain:
Approximate Duct Pressure, (iwg):
tr
above
tr
other
tr
below
tr
+3 to +7
lf nther cvnlain'
-3 to +3 +7
rfv r Nlt)N ll(L))t
Sampling Location: Stack Port _
Approximate Sampling Platform Height, (ft)
PRE.MOBILIZATION TEST INFORMATION
Page 2 of 2
Duct Port
tr
below 6
lf other, explain:
tr
other
Other:
trtrtr
6 to 50 50 to 100 above 100
Access and Protection:
Elevators: _ Ladders: _ MEWP Lift: _ Scaffold: _ Equipment Hoist: _
Guardrails: _ Toe plate: _ Engineered Tie Off Points: _ Heat Shield: _
Describe how equipment will be mobilized to the sampling location:
Additional lnformation :
Effluent Chemical Requlatorv Limits
Gas Name Chemical
Formula
Cal OSHA PELI
(ppm)
Cal OSHA
STEL2(ooml
NIOSH REL
TWA3 (ppm)
Cal OSHA
Geiling
(oom)
tDLH.
(ppm)
3arbon Monoxide co 25 200 35 200 1,200
Nitric Oxide NO,25 ND5 25 ND 100
Sulfur Dioxide SOz 2 5 2 ND 100
Hvdrooen Chloride HCt 0.3 2 ND 2 50
Hydrogen Sulfide HzS 10 15 10 (10 min.)c 50 100
)alifomia Occupational Safety and Health Administration (OSHA) Permissible Exposure Linit (PEL) based on an ?-hour shift;
2: Cal OSHA Short-term Exposure Limit (STEL) based on a 11-minute period;
3: National lnstitute for Occupational Safety and Health (NIOSH) Recommended Exposure Limit (REL) Time-weighted Average (TWA) based
on an 8-hour shift;
4: lmmediately Dangerous to Life or Health (IDLH);
5: Not Defined (ND);
C: Ceiling Limit - Maximum allowable human exposure limit for an aitbome or gaseous subslanco, which is not to be exceeded, even
momentarily.
ta{\ fv.-l()N I KL)}1 Job Hazard Analysis
Error Rlgk
E Time Pressure E Remote Work Location E > 12 hr shift ! working > 8 consecutive days
E Lad of procedures E Extreme temps, wind >30mph E Personal illnesslfatigue E Vague work guidance
E Monotonous Activity E first day back aftertime off E ttuttipteioO locations E other:
Physical Hazards Hazard Controls
Dust Hazards i E Dust Mask I Goggles E otner
Thermal Bum i E xot Gloves E Heat Shields E other P;6iir" clothins'
-Electrical Hazards i E Connections Protected from Elements I External GFCI E Otfril
E Xe nating Requirement E lntrinsically Safe Requirement
lnadequate Lighting ! E tnstatt Temporary Lighting E Headlamps
Slip and Trip i E Housekeeping E Barricade Area E Other:
Hand Protection i El Cut Resistant Gloves E pinch Pts. E General E ebctrical ! lmpaa Resistant
E other:
Potential Hazards for Consideration
Secondary Permits i E not Work trl Confined Space f] Excavation
Wo*ing from Heights i E f"tting objects ! Fdl protection E Drop zone protection E] ptatform load ratings
see alro Sect.7 ! ! ScanotO inspection E Laoder inspection E Barricades for equipment
Electrical i E gxposeO wire/connector E Verify equipment groundinS E Arc Flash
Lifting i E Crane lift plan fl Rigging inspection E fag lines used E Hoists in place
Respiratory i E Unexpected exposure E Chemical E Dust (combustible) E PEL provided
E cra.i ! Gas detection equiSee also Sect. 8 : U Cartridqes or supplied air available
1of 3
1.
2.
3.
4.
llient lontact Name Date
=acilitv SSP Writer PM
3lient Rep I
Job Preparation
! .too Site Walk Through completed tr
I Sate Work Permit Received from Client
_J
Site Specific Training Complete
lf the heat index is expected to be above 91", fill out the Heat Stress Prevention Form.
acility lnformation/Emergency Preparedness
lf non+mergency medical attention is needed, call: AXIOM #: 877-502-9466.
Plant Emergency #
EMS Location
Certified First Aid Person:
Evacuation Routes Rally Point
Severe Weather Shelter Location Eye Wash & Safety Shower Location
EYes ENo
Source lnformation: (list type):
Stack Gas Temp. ("F) Stack Gas Press. ("HrO) Stack Gas Components:
Stack Gas lnhalation Potential? EYes E No tf ves. see List of Hazard Chemacats.
lPanrrirar{ FDF l-'l Ft a rd t{ af c l-'l Safahr Glaeeaq J-'l Safphr Tno Shoc/Rnnt l-'l l'.lcarinn Pr^ta^ti^n l-lSafot., SnntfarB
/a" \ MtJN I,RU-\t
Additional Work Place Hazards
Job Hazard Analysis 2of3
ritical Procedures - check all that apply - *indicates additional form must be completed or collected from client
E Heat Stress Prevention* E Confined Space' El MEWP' E Roof Work E Scattoto
E CotO Weather Work ! Hazardous Energy Controt- E Exposure Monitoring E Other:
7.From Heights
Fall Protection i! Fixed Guardrails/Toe boards E] fatt Prevention PPE Warning Line System
Falling Objects Protection ! E aartcaaing El Uetting fl House Keeping ! Tethered Tools El Catcn Blanket or Tarp
Fall Hazard Communication i E Adjacenuoverhead Workers E Contractor Contact E Client Contact
8.Other Consideratione
Environmental Hazards - Weather Forecast
E HeaUCotd Eltigntning E Rain E Snow I lce E Tornado ! Wind Speed
Steps for Mitigation:
Electrlcal Safety Planning
Plant Hook up: E t tov E 22ot24ov E +aov E Generator E Hard wired into panel
Electrical Classified Area: fJYes fl No Trailer Grounded: E yes E f'lo Plug Type
Electrical Hook Up Responsibility:
List of Hazardous Chemicals
E Acetone E Nitric Acid E Hydrog"n Peroxide I compressed Gases
fl Hexane E Suffiuric Acid E lsopropyl Alcohol I Flammable Gas
E Toluene E Hydrochloric Acid f] liquio Nitrogen ! Non-Flammable Gas
E nzs E Carbon Monoxide
Steps for Mitigation:
lildlife/Fauna in Area
! Poison lvy I Poison oak Elnsects:IWildlife:
Personnel w/ known allergies to bees stings or other allergens? [ Yes Euo
1
2
3
't
2
3
1
2
3
1
2
3
1
2
3
1
2
3
Hazards and Mitigation
Hazard(s)Mitigation
,a".MLJNlKL),-\t Job Hazard Analysis 3of3
JHA REVIEW: Crew Names & Signatures
Printed Name Signature Date Printed Name Sisnature Date
JHA Meetinq & Review
Items to revlew:
o Change in conditions o Extended work hours r Daily Safety Topic
o New workers or contractors r Occunence of near misses or injuries
lnitialing demonstrates that site conditions and hazards have not changed from the original SSP. lf changes did occur, make the
necessary updates to this JHA and add notes as applicable in Section 9.
Day Diecuselon Toplc lnltlalr
2
3
4
5
6
7
I
I
10
11
rf,, r i'vl(/r\ i lr( )\l
Poge 1 of 2
EMERGENCY ACTION PLAN FORM
The Job Supervisor/ Client Project Manager (CPM) will ensure that all employees are familiar with the facility emergency and evacuation
procedures, assembly/ rally points, alert systoms, and signals prior to work commencing. ln the event of an emergency situation/
evacuation, the Job Supervisor/ CPM will maintain a roster and be responsible for accounting for all employees. The Job Supervisor/
CPM will ensuro that this Emergency Action Plan Form is completed, communicated to all employees, and posted.
.You must follow the client's emergency action plan fir6t, and notify your Supervisor immediately.
.lf incident is life threatening, CALL 911 IMMEDIATELLY
.lf non-emergency medical attention is needed, call N(IOM Medical number: 877-502-9466.
1 MEG Job Supervisor/ CPM's Name:
2 MEG Job Supervisor/ GPM's Telephone Number:
3 MEG Job Safety Supervisor (if applicable):
4 MEG Job Safety Supervisor's Telephone Number:
5 Plant's Emergency Telephone Number:
6 Local Hospital/ Clinic Telephone Number:
7 Emergency Ops Radio Ghannel:
8 PIant's #1 Contact Person's Name:
9 Plant's #1 Contact Person's Telephone Number:
10 Plant's #2 Contact Person's Name:
11 Plant's #2 Contact Person's Telephone Number:
12 Designated Assembly Point Location:
13 Evacuation Routes:
14 Severe Weather Shelter Location:
15 Eye Wash and Safety Shower Location:
,a",Mt]NIRU)t Page 2 of 2
EMERGENCY EVACUATION AND ASSEMBLY MAP
Facility Name:
CHEMICAUGAS: ;
SHELTER.IN-PUCE: :
Shelter(s) Description:
Assembly Point(s) Description:
EMERGENCY ACTION PLAN FORM AND EVACUATION ASSEMBTY MAP REVIEW: Crew Names and Signatures
[viNlLri\iK\)\t Page 1 of 1
Daily MEWP Lift lnspection Form
All checks must be completed prior to each work shift, before operation of the MEWP lift. This checklist must be used
atthe beginning of each shift or following 6 to 8 hours of use.
MEWP Lift Model #:Serial Number:
Make:Rented or Owned:
r Check "Yes" if an item is adequate, operational, and safe.. Check "No" to indicate that a repair or other corrective action is required prior to use.. Check "N/A" to indicate "Not Applicable."
Items to be lnspected
1. All MEWP lift components are in working condition (i.e. no loose or missing parts, torn orloose hoses, etc.) - if something can be easily loosened by hand then it is not sufficient.
2. Hydraulic fluid level is sufficient, with the platform fully lowered
3. Hydraulic system pressure (see manufacturer specs) is acceptable.
lf the pressure is low, determine cause and repair in accordance with accepted procedures
as outlined in service manual.
4. Tires and wheel lug nuts (for tightness)
5. Hoses and cables (i.e. worn areas or chafing)
6. Platform rails and safety gate (no damage present)
7. Pivot pins secure
8. Welds are not cracked and structural members are not bent or broken
9. Warning and instructional labels are legible and secure, and load capacity is clearly marked.
10. Manufacturer's lnstruction Manual is present inside the bucket
11. Base controls (switches and push buttons) can be properly operated
12. Platform conditions are safe (i.e. not slippery)
13. Fire extinguisher is present, mounted and fully charged, located inside the bucket
14. Headlights, safety strobe light and back-up alarm are functional
15. Workplace is free of hazards (overhead powerlines, obstructions, level surface, high winds,
etc.)'Do not operate if winds are 20 mph, unless otherwise specified by manufacturer
recommendations.
Yes
tr
tr
tr
tr
n
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
N/A
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
tr
!
No
tr
n
tr
tr
!
n
tr
tr
tr
tr
n
n
tr
tr
n
Operator Name & Signature Location
Harness lnspections:
LocationGround Control Name & Signature
6n- yo N TROSE
Page 1 of 1
Extended Hours Safety Audit
Project Number:Date:Time:
When a project is expected to extend past a 14-hour work day, this form must be completed to evaluate
the condition of the crew, and the safety of the work environment.
Permission to proceed into extended work hours must come from a District Manager (DM) or Regional Vice
President (RVP). Technical RVPs can authorize moving forward, if they are in the field or if they are
managing the project.
1. Hold test crew meetinq Test crew initials:
. Temperature and weather o Hoisting. Lighting . PPE (i.e. respirators, etc.)o Working from Heights r Pollutant concentration in ambient air (SOz,
HzS, ect.)
Notifv DM or RVP
The PM must contact either the DM or RVP to discuss the safety issues that may arise due to the
extended work period. lf the DM is the acting PM on the job site, they must contact the RVP.
During this time, they can come to an agreement on how to proceed. ltemsto discuss include:
a
a
I
a
Reason for extended hours
Reason for delay
Production limitations
lmpending Weather
Contact the client
The PM, DM or RVP must discuss with client any identified safety concerns, the client's needs and
mutually agree on how to proceed. Discussion should also include the appropriate rest period
needed before the next day's work shift can begin. The DM and/or a RVP must be informed on the
finaldecision.
2.
3.
The test leader should look for signs of the following in their crews:
r lrritability. Lack of motivation. Headacheso Giddiness
. Fatigue. Depression. Reduced alertness, lack of concentration and
memory
The test leader should assess the environmental and hazardous concerns:
FinalOutcome:
1.
2.
/ar\ MLJN I RU)t
Page 1 of 1
Heat Stress Prevention Form
This form is to be used when the Expected Heat lndex is above 91' F, and is to be kept with project
documentation.
Proiect Manaqer (PM):Exoected Hioh Temo:
Date(s):Expected Heat lndex:
Review the signs of Heat Exhaustion and Heat Stroke
lf Heat lndex is above 91" F:r Provide cold water and/or sports drinks to allfield staff (avoid caffeinated drinks and energy
drinks which can increase core temperature).
o Bring no less than one gallon of water per employee. lf employee(s) are dehydrated, on blood pressure medication or not acclimated to heat,
ensure they are aware of the heightened risk for heat illness. Provide cool head bands/vests/etc.o Have ice available to employees. lmplement work shift rotations and breaks, particularly for employees working in direct
sunlight.. Provide as much shade at the jobsite as possible, including tarps, tents or other acceptable
temporary structures.r PM should interview each field staff periodically to evaluate for signs of heat illness
lf Heat lndex is above 103" F:. Employees must stop for drinks and breaks every hour (about 4 cups/hour). Employees are not permitted to work alone for more than one hour at a time without a
break offering shade and drinks. Employees should wear cool bands and vests if working outside more than one hour at a
timeo PM should interview each field staff every 2 hours to evaluate for signs of heat illness
3.
;, Cel, p.le,
6 clammy rkln /
Nausa orwmlting ffi Nausa or rcmltint
R.pid,wakpul*
-
Rapid,stronSpul*
Musctecnmps II Mayto*(i')
UTAH DEPARTMENT OF
ENVIRONMENTAL QUALITY
DIVISION OF AIR OIJALITY
This is the Last Page of This Document
If you have any questions, please contact one of the following
individuals by email or phone.
Name: Craig Kormylo
Title: District Manager
Region: USA - Stack - Great Plains - Operations
Email : [e-mail]
Phone: [phone]
Name: Glen Capra
Title: Vice President
Region: USA - Stack
Email : [e-mail]
Phone: (5L2) 772-6450